Clinical characteristics and treatment outcomes of adult acute promyelocytic leukemia in the West Bank of Palestine: a single center retrospective study
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Background
Acute promyelocytic leukemia (APL), a distinct subtype of acute myeloid leukemia (AML), accounts for 5–20% of AML and carries a high risk of early, often hemorrhagic, mortality related to disseminated intravascular coagulation (DIC). With all-trans retinoic acid (ATRA) and arsenic trioxide (ATO), APL has become highly curable, with survival approaching 90%. Data from Palestine are limited. This study addresses an important regional data gap by describing the presentation, complications, and outcomes of adults with APL treated at a tertiary Palestinian cancer center and by comparing patients with and without early death.
Methods
We retrospectively reviewed 30 adults (≥18 years) diagnosed with APL at An-Najah National University Hospital (NNUH), West Bank, Palestine, between January 2016 and June 2024. Patients were classified as standard-risk (WBC ≤10×10⁹/L) or high-risk (WBC >10×10⁹/L). Standard-risk patients received ATRA+ATO induction, whereas high-risk patients received ATRA plus anthracycline-based induction. Consolidation with ATRA+ATO was given to patients who proceeded to consolidation in both groups. Early death was defined as death within 30 days of diagnosis.
Results
The cohort included 15 males and 15 females, with a median age of 37 years (range, 18–79 years); 22 (73.3%) were standard-risk and 8 (26.7%) were high-risk. Median baseline values were hemoglobin 9.0 g/dL, WBC 4.8×10⁹/L, platelets 18.1×10⁹/L, ANC 0.95×10⁹/L, PT 17.2 s, aPTT 27.45 s, fibrinogen 142.5 mg/dL, and D-dimer 30.9 mg/L FEU. Early death occurred in 13.3% (4/30) and was hemorrhage-related in the setting of coagulopathy/DIC. All patients who survived beyond 30 days achieved complete hematologic remission. Kaplan–Meier overall survival was 96.4% at 1 year and 87.7% at 2 years; median overall survival was 56.2 months (95% CI, 33.6–78.9). Compared with patients without early death, those with early death had higher admission WBC counts, longer aPTT, and more frequent ICU admission.
Conclusions
In this single-center Palestinian cohort, ATRA-based treatment yielded high remission rates and no observed relapse during follow-up. Early mortality remained the main barrier to cure and occurred in patients presenting with a higher leukocyte burden and evidence of more severe coagulopathy. Prompt diagnosis, immediate ATRA initiation, and intensive supportive care remain essential in resource-limited settings.
